Neurology Expert Forum
breezer22
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This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.

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breezer22

Is it possible for an emg to miss LMN signs associated with ALS when done by an ALS specialist with decades of experience.  My most recent emg was clean apart from a couple of fasciculations. It was completed by a senior neurologist at Cleveland Clinic. Thanks for your prompt reply. Please be as specific as possible. I know emgs are only part of the diagnostic process. My question is in regard to ACCURACY  of emgs picking up ALS signs. My symptoms had been present for a year and a half.
Avatar_dr_m_tn
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

An EMG when done correctly is a very sensitive test for diagnosing ALS. However please remember that NO test is 100%, so theoretically an EMG could fail to detect the typical ALS changes if they are very mild or the disease is so early that the abnormalities are below the sensitivity of the EMG to detect. Also remember that the EMG is an operator dependent test so the result is dependent on the technique and interpretation abilities of the person doing it.

Another scenario to consider is that when one has an EMG and it turns out normal, the reason being one doesnt have ALS at that time. However, by coincidence if at some point in the future, one develops this disorder, then the EMG can test positive later on.

It is re-assuring to hear that you have been evaluated by an experienced neurologist specializing in ALS and have a normal EMG. I would recommend trusting your doctor and following up with him/her if you develop any new symptoms in future.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck
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